Gestational Diabetes

Question:

I suffer from polycystic ovaries and had heard that this can cause insulin resistance, I’m not sure if that is true

Actually IR ~causes~ PCO, not the other way around. Beth

Response:

Debbie Please let us know how it all goes. Good luck for the birth! Love Cath

– Hide quoted text — Show quoted text – I suffer from polycystic ovaries and had heard that this can cause insulin resistance, I’m not sure if that is true Actually IR ~causes~ PCO, not the other way around. Beth

Response:

Cathie They have said that it will go away, but since my father is a Type 2 and his mother was Type 1, I will probably end up with Type 2. I suffer from polycystic ovaries and had heard that this can cause insulin resistance, I’m not sure if that is true and if so what effect it will have on me, I guess its just a case of wait and see, only another 6 weeks until the baby is born. Debbie

– Hide quoted text — Show quoted text – Has anybody talked to you about whether the diabetes might go away when you have had your baby? Mine did! But it came back when I went on the pill (contraceptive pill). I was sterilised in the hopes that this might aid the diabetes – on the basis that the pill mimics pregnancy (if my body thinks it’s pregnant then it becomes diabetic, so stop taking the pill, my body won’t think I’m pregnant, and the diabetes will go away – I was 21 when sterilised), but it didn’t work, I was stuck with it. However thinking back, I was about the 10th in the family with diabetes so I’m not surprised (with hindsight) that it didn’t go away). Good luck with the pregnancy, I’m sure you’ll have a lovely baby – mine was a healthy 9lbs 12oz boy, 22 years ago. Fingers crossed the diabetes goes away after delivery.

Response:

chech next week for more information on diabetes. alan

Response:

Has anybody talked to you about whether the diabetes might go away when you have had your baby? Mine did! But it came back when I went on the pill (contraceptive pill). I was sterilised in the hopes that this might aid the diabetes – on the basis that the pill mimics pregnancy (if my body thinks it’s pregnant then it becomes diabetic, so stop taking the pill, my body won’t think I’m pregnant, and the diabetes will go away – I was 21 when sterilised), but it didn’t work, I was stuck with it. However thinking back, I was about the 10th in the family with diabetes so I’m not surprised (with hindsight) that it didn’t go away). Good luck with the pregnancy, I’m sure you’ll have a lovely baby – mine was a healthy 9lbs 12oz boy, 22 years ago. Fingers crossed the diabetes goes away after delivery. Best wishes, Cathie "It might look like I’m doing nothing, but at the cellular level I’m really quite busy."

– Hide quoted text — Show quoted text – You should ask your nutritionist…but when I had GD, I was told to eat a snack of 2 carbs and 1 protein before bed. Mine was controlled by diet and exercise alone though. I didn’t use insulin. Hi everyone <snip My question is should I eat something before I go to bed, I’m worried that my BM will drop too low overnight. Any advice would be much appreciated. Thanks Debbie

Response:

You should ask your nutritionist…but when I had GD, I was told to eat a snack of 2 carbs and 1 protein before bed. Mine was controlled by diet and exercise alone though. I didn’t use insulin. Hi everyone <snip

My question is should I eat something – Hide quoted text — Show quoted text – before I go to bed, I’m worried that my BM will drop too low overnight. Any advice would be much appreciated. Thanks Debbie

Response:

My endo wanted my 2 hour after meal readings to be in the low 5’s. My morning one was always higher so I was increasing the dose at night towards the end. I don’t know what eating before bed would have done because I didn’t really go into the ins and outs of diabetes during my pregnancies cause I figured it was just short term. Some people say some small bit of carbs with fat, e.g. cracker with peanut butter before bed helps lower that higher morning reading. I never had a hypo during pregnancy diabetes while on insulin, I believed it was the nature of that type of diabetes – unless I misheard my endo.

Hi everyone I don’t know if you can help me but I’ve just been diagnosed with Gestational Diabetes and have started insulin this week

(Humulin 3) 15 units at night and 20 units in the morning. So far my BM has been ranging from 8.2-9.1 2 hrs after eating whilst on 12 units, tonight I had to increase my dose to 15 units and my BM was 5.4 2hrs after eating.

Usually by morning by – Hide quoted text — Show quoted text – BM has dropped tobetween 5.4-6.3. My question is should I eat something before I go to bed, I’m worried that my BM will drop too low overnight. Any advice would be much appreciated. Thanks Debbie

Response:

Hi everyone I don’t know if you can help me but I’ve just been diagnosed with Gestational Diabetes and have started insulin this week (Humulin 3) 15 units at night and 20 units in the morning. So far my BM has been ranging from 8.2-9.1 2 hrs after eating whilst on 12 units, tonight I had to increase my dose to 15 units and my BM was 5.4 2hrs after eating. Usually by morning by BM has dropped tobetween 5.4-6.3. My question is should I eat something before I go to bed, I’m worried that my BM will drop too low overnight. Any advice would be much appreciated. Thanks Debbie

Response:

Actually, the ADA released a new standard last year beased on using a Fasting Plasma Glucose test, NOT the old GTT. Levels over 126 mg/dl are now considered as diagnostic for diabetes. Ted Quick

Response:

Is a 1 hour gtt no good at all? I wouldn’t have agreed to take it if I’d known it was a useless test. I thought a 4 hour gtt would have risks of its own…is that the standard for diagnosis? Could there be risks to a foetus with taking the 4 hour gtt? Actually, the ADA released a new standard last year beased on using a Fasting Plasma Glucose test, NOT the old GTT. Levels over 126 mg/dl are now considered as diagnostic for diabetes.

The normal screening for gestational diabetes is still the 50 gram 1 hour GTT, although 2 and 3 hour tests are used by some. The fasting glucose test is the standard screening test for the general population. You can be diagnosed by a random bg, fasting bg, or GTT. See http://www.diabetes.org/DiabetesCare/Supplement198/S5.htm for a full discussion. — Charly Coughran

Response:

: I am really a neophyte and a lot of the language is new to me, so thank : you, because I didn’t know this already. Help me out a bit more if you : could, please: what is postprandial? And what does a casual glucose test : mean in this chart you sent? According to this chart, I fit into the : nondiabetic category. Am I correct in that? (fasting glucose 4.9 mmol/L, : 1 hour gtt 10.1mmol/L) the gtt levels are for two-hour tests — i’m not sure that you can discern anything from the one-hour test. fasting glucose refers to a lab value taken after you’ve been fasting at least 8 (i think) hours. postprandial just means "after eating." a casual test is one taken at any time, without regard to what you’ve eaten or when it was eaten. basically, if you ever go over 200 (11), you’re diabetic. if your two-hour gtt value is also around 10, you’d be considered to have impaired glucose tolerance. i don’t know if this is considered to be as much a cause for concern in pregnancy as diabetes. the ada bg goals for pregnant women with diabetes [mg/dl(mmol/l)]: before meals: 60 (3.3)-105 (5.8) one hour after: 110 (6)-130 (7.1) two hours after: 90 (5)-120 (6.6) middle of the night: 60 (3.3)-120 (6.6) they define middle of the night as 2-3 am. i don’t remember whether you said you’re seeing an endocrinologist. if you aren’t yet, you probably should. — sine | deb hoping this is useful

Response:

A glucose tolerance test should be takin over a four hour period to check for diabetes. Blood taken and checked each half hour for glucose (mg/dl).

Response:

Is a 1 hour gtt no good at all? I wouldn’t have agreed to take it if I’d known it was a useless test. I thought a 4 hour gtt would have risks of its own…is that the standard for diagnosis? Could there be risks to a foetus with taking the 4 hour gtt? Thanks for your response Arnold, –Kate MacLean (still full of questions :-) – Hide quoted text — Show quoted text – A glucose tolerance test should be takin over a four hour period to check for diabetes. Blood taken and checked each half hour for glucose (mg/dl).

Response:

Hi deb, I am really a neophyte and a lot of the language is new to me, so thank you, because I didn’t know this already. Help me out a bit more if you could, please: what is postprandial? And what does a casual glucose test mean in this chart you sent? According to this chart, I fit into the nondiabetic category. Am I correct in that? (fasting glucose 4.9 mmol/L, 1 hour gtt 10.1mmol/L) Thanks again, Kate MacLean – Hide quoted text — Show quoted text – the diagnostic criteria are: fasting 2nd hour glucose casual glucose glucose test tolerance test test nondiabetic < 6 (110) < 7.8 (140) < 11 (200) impaired 6-6.9 (110-126) 7.8-11 (140-200) diabetic 6.9 (126) 11 (200) = 11 (200) postprandial measures are done for control, not for diagnosis; i agree that it’s not appropriate to compare a glucose tolerance test with a postprandial test, and a postprandial test is not a good way to diagnose diabetes of any sort. but post-meal testing *is* a good way to track what your bg is doing and whether your diabetes is under control.

Response:

: But is comparing an after-meal glucose level equivalent to a 50 gram : glucose dose? Correct me if I’m wrong, but I would think a regular meal : would not be as glucose-intense as the orange crap they made me drink…and : therefore my 1 hour glucose *may* still have been under 150 mg/dL. the diagnostic criteria are: fasting 2nd hour glucose casual glucose glucose test tolerance test test nondiabetic < 6 (110) < 7.8 (140) < 11 (200) impaired 6-6.9 (110-126) 7.8-11 (140-200) diabetic 6.9 (126) 11 (200) = 11 (200) postprandial measures are done for control, not for diagnosis; i agree that it’s not appropriate to compare a glucose tolerance test with a postprandial test, and a postprandial test is not a good way to diagnose diabetes of any sort. but post-meal testing *is* a good way to track what your bg is doing and whether your diabetes is under control. — sine | deb who figures you knew this, bu wanted to clarify

Response:

Hello Janet, First, thank you very much for your response and information. (And congrats on your baby girl, too. :-) You would still be diagnosed with Type 2 diabetes. A normal one-hour post-prandial (after meal) blood glucose for a non-pregnant non-diabetic in under 150 mg/dl. However, a type 2 diagnosis is usually made based on fasting levels these days, and your fasting blood glucose is normal.

But is comparing an after-meal glucose level equivalent to a 50 gram glucose dose? Correct me if I’m wrong, but I would think a regular meal would not be as glucose-intense as the orange crap they made me drink…and therefore my 1 hour glucose *may* still have been under 150 mg/dL. (I had this test done about a year before I got pregnant and they said my levels were normal, although I didn’t actually see the results myself. NOW: Pregnant (non-diabetic) women have lower blood glucose levels than not pregnant, not diabetic women. That’s why your doctors want to compare you to a different standard. For a pregnant woman, ANY blood glucose level over 130 mg/dl is too high.

And what I’m telling you is that there are many many doctors and medical professionals who *do not* believe in comparing pregnant women’s blood sugars to a different standard. You are simply telling me what my midwives and the doctor is telling me, and I am trying to explain that these protocols can be debated. In fact, in Europe, doctors are generally satisfied that gd does not exist. The studies show that there is *no difference* in maternal and infant outcomes compared between treated and untreated groups of women diagnosed with gd. The pregnancy hormones make you insulin resistent. Therefore, you need to produce more insulin to keep your blood glucose levels normal while pregnant (in the second and third trimester). Therefore, although your pancreas may be able to keep up with your normal demands while not pregnant, it has to work harder during pregnancy and may need some help then. Just because you have diabetes during pregnancy does not mean that you will have it afterwards — your insulin requirements will be lower post-partum.

There is also the possibility that the pregnant body is *supposed* to have higher levels of glucose. No one has done any studies based on this possibility. Btw, it sounds like your main complaint with your first pregnancy is that you were induced and ended up with a c-section. Just because you are diabetic doesn’t mean that you need to be induced early. And just because someone is not diabetic doesn’t mean they won’t be induced.

In fact, women with gd have a much much higher rate of c/section than other women. Because of the medical practice of (mis-) managing pregnancies. The standard practice is to induce gd women early, which *usually* leads to a c, and all the risks inherent in that procedure (which I believe is much too commonplace these days anyway). I think this practice needs to change. BUT: there are real potential complications for the baby if you have high blood glucose levels.

This is a true fact, when you are speaking about Types 1 and 2 diabetes. It is *not* true regarding gestational diabetes. The studies that have been done in the last 10 years do not confirm this statement at all. Please read Obstetric Myths versus Research Realities by Henci Goer to understand what I’m talking about. Thanks again for your input. Kate MacLean (mommy to Spencer 13Apr95, and ??? due 16 September) Toronto, Ontario Canada

Response:

I took a 50 gram Glucose Tolerance Test last week, and my blood sugar levels came back looking like this: fasting: 4.9 mmol/L ( = 88.2 mg/dL) 1 hour: 10.1 mmol/L ( = 181.8 mg/dL) What I would like to know is, if I weren’t pregnant would these levels be reasonable, or have I kicked into Type 1 or Type 2 Diabetes?

You would still be diagnosed with Type 2 diabetes. A normal one-hour post-prandial (after meal) blood glucose for a non-pregnant non-diabetic in under 150 mg/dl. However, a type 2 diagnosis is usually made based on fasting levels these days, and your fasting blood glucose is normal. NOW: Pregnant (non-diabetic) women have lower blood glucose levels than not pregnant, not diabetic women. That’s why your doctors want to compare you to a different standard. For a pregnant woman, ANY blood glucose level over 130 mg/dl is too high. The pregnancy hormones make you insulin resistent. Therefore, you need to produce more insulin to keep your blood glucose levels normal while pregnant (in the second and third trimester). Therefore, although your pancreas may be able to keep up with your normal demands while not pregnant, it has to work harder during pregnancy and may need some help then. Just because you have diabetes during pregnancy does not mean that you will have it afterwards — your insulin requirements will be lower post-partum. Since I have type I diabetes, I measured ALL of my insulin (it was all injected via a pump) while I was pregnant. I started out using about 25 units a day, but in the third trimester I was using 50-55 units a day. Post-partum, I dropped back to 20 units a day. Btw, it sounds like your main complaint with your first pregnancy is that you were induced and ended up with a c-section. Just because you are diabetic doesn’t mean that you need to be induced early. And just because someone is not diabetic doesn’t mean they won’t be induced. BUT: there are real potential complications for the baby if you have high blood glucose levels. Whatever you need to do to control them — do it. I had to stop working the last 4 months of my pregnancy in order to have enough time to manage my diabetes. I have a healthy 15 month old girl. It was worth it. Janet

Response:

Hello folks, I have a bunch of questions I’m hoping your collective wisdom can help me out with. I took a 50 gram Glucose Tolerance Test last week, and my blood sugar levels came back looking like this: fasting: 4.9 mmol/L ( = 88.2 mg/dL) 1 hour: 10.1 mmol/L ( = 181.8 mg/dL) The protocols for this lab indicate that the fasting results should be 4.0 to 6.0, which is fine, but for the 1 hour glucose they say that a gestational glucose tolerance test is recommended when the 1 hour glucose value is 7.8 mmol/L ( or 140.4 mg/dL). What I would like to know is, if I weren’t pregnant would these levels be reasonable, or have I kicked into Type 1 or Type 2 Diabetes? I have been doing a lot of reading since my first pregnancy (my son turned 3 this month), and I know that there is a lot of controversy regarding the "diagnosis" of gestational diabetes. The first time, I was diagnosed with gd, I worked on the diet and monitored my bg and ketones 4x/day, then when the endo saw the bg levels in my notebook she felt that insulin was necessary, so I started injections 2x/day, which continued until the day my son was induced 12 days early (he was supposed to be big but he was not). The inducion failed, I ended up with an unnecessary, avoidable c/section; the sugar problems disappeared _immediately_ upon delivery for me and never appeared at all for the baby. I am overweight, but otherwise healthy, and I have no family members with diabetes, and have no other indications for it. I have read The Emperor’s New Clothes, by Henci Goer, which is an article about gd, and how the whole "disease" is based on faulty premises and studies, and I am currently wading through her book Obstetric Myths versus Research Realities. I am quite convinced that there is no such thing as "gestational diabetes". I have told my midwives that if I have crossed over into T1D or T2D, I want to know about it, but until then I will not accept the diagnosis of GD. I am covering my butt, however, by eating properly, no sweets, and spacing out my foods and watching the sugar intake. But the diet that I am more or less following: The Brewer Medical Diet for Normal and High-Risk Pregnancy by Gail and Thomas Brewer, states in the book that I should insist that my blood sugar levels be compared to the general population protocols, not the pregnant population ones. My problem is mainly that I can’t get a straight answer out of anyone because they just keep saying "but you’re pregnant, it’s different." I get so frustrated. Sorry to be so long-winded, I’d appreciate any answers I get, and can you please cc me because I don’t get much computer time these days. I also would like to know how to get at the FAQ’s, if someone can direct me. Thanks again, Kate MacLean toronto, ontario, canada

Response:

I was diagnosed with GD recently (I’m at 24 weeks), and have been checking blood glucose levels for about two weeks, with minimal lifestyle changes except for a drastic reduction in the amount of fruit juice I drink. What’s puzzling me is that my numbers rarely seem to be close to the limits of 90 fasting/120 2 hours after a meal. My fasting levels range between 74-88 (averaging around 81); my 2-hour readings are 72-111 (averaging around 89). To me, these don’t sound like diabetic levels, but the 3-hour GTT said differently. I’m starting to think that all this finger pricking is a waste of time. Has anyone else with GD had BG levels like mine? Were yours much higher or lower? What problems arose during labor or delivery? I know I need to take this seriously, but it’s difficult when I feel so normal and my sugar seems to agree.

Response:

Matthew & Michelle, Congratulations on your pregnancy. I was a gestational diabetic with both of my pregnancies…I now how two healthy boys ages 4 and 18 mos. The thing I found most helpful from my husband was his acting as if he had the diabetes also. He would help me weigh my food, eat what I ate, etc. The emotional support is VERY important as your wife will be making some major lifestyle changes. The diabetes could also change how your wife’s delivery goes also so she will need your support. As for signs to look for the only signs you would need to pay attention to would be if she is on insulin (not all Gest. Diab. take insulin, I did). If she reports feeling dizzy, sweaty/cold, or doesn’t act like herself have her test her blood sugars as they may be low. It is important not to get low when you are pregnant just like high bgs are not good. As an aside also be prepared for your wife to possibly have lots of tests during her pregnancy and for her to deliver the baby early (depends on your OB) I was induced with both of mine but did not have a C-section with either. If I can help in any way let me know as I understand how overwhelming it can be!

Response:

Hi all, My wife and I are expecting our first child in September and yesterday (Friday) she was diagnosed with gestational diabeses. She has had problems with hypoglycemia for several years and was actually diagnosed with type 2 on Thursday. I was wondering what I can do as a spouse and what signs I to watch for to be sure that she is not having any problems. Insulin reactions, too low/high, etc… Any help that you or your spouses can offer me would be greatly appreciated. Thank you Matthew & Michele Miller

Response:

I’m not sure exactly how to tell how severe the GD is, to be honest. They started me on just the diet when I was first diagnosed, but after a week and a half they put me on insulin (Mixtard 30/70). I started off with 6 units of insulin before breakfast and 4 before dinner. Now two weeks later I’m on 10 in the morning and 12 at night. Our adventure of joy involving GD was the day after, when she couldn’t eat her lunch due to trying to eat it so frantically and I recognized the signs of my own (30 year Type 1!) insulin reactions, got her to eat her dessert first and drink juice. So keep an eye out for bounces the next day as your system normalizes.

Ahh good advice, I probably wouldn’t have even thought of that. And keep an eye on the nurses doing the glucose testing on the baby. The kid will be upset enough at this whole process, and we had problems with the amazingly poorly designed infant glucometer. It won’t rest stably on the table, you can’t easily place the 3" sticking out strip on the kid’s now bloodied foot since you don’t have a hand free to control the cardboard strip and it bobbles, and the automatic powerdown is set *much* too short. Make them use the little capillary tube to draw the kid from the kid’s foot and transfer it to the pad, it just Works Better(tm).

Thanks for that advice too. I’m saving all the answers I’ve received:) slowly.

Response:

GP advised that I was at greater risk to develop t2 if I didn’t loose weight. I lost some weight and went stupidly along thinking I was okay, now I know better. It’s my own fault, I should have researched the subject and found out what I needed to do and what to watch for. Val

Thanks Val, I’ve been advised to ensure I get to a healthy weight as soon as I can (when it’s healthy to do so) and have yearly gtt’s but nothing else so far. I plan on asking for more information next time I see the docs. slowly.

Response:

Hi, I’ve been diagnosed with Gestational Diabetes and I’m on insulin (Mixtard 30/70) twice a day. I’m wondering if there’s anyone else reading this group with GD – or if someone has had GD with a previous pregnancy. I’m mainly looking for information on the birth process and what ‘interventions’ can occur. My OB has advised I’ll have a glucose drip, insulin pump and hourly blood glucose readings while in labour and I’m looking for other people’s personal experiences. If you’d prefer to email me, feel free. The reply address is valid. slowly.

My wife had it, and had an IV after our arrival at labor+delivery, until after breakfast in the post-partum room. So far as I remember, she didn’t require additional glucose, nor did they provide one in the IV. How severe is your GD? How much insulin are you taking? Our adventure of joy involving GD was the day after, when she couldn’t eat her lunch due to trying to eat it so frantically and I recognized the signs of my own (30 year Type 1!) insulin reactions, got her to eat her dessert first and drink juice. So keep an eye out for bounces the next day as your system normalizes. And keep an eye on the nurses doing the glucose testing on the baby. The kid will be upset enough at this whole process, and we had problems with the amazingly poorly designed infant glucometer. It won’t rest stably on the table, you can’t easily place the 3" sticking out strip on the kid’s now bloodied foot since you don’t have a hand free to control the cardboard strip and it bobbles, and the automatic powerdown is set *much* too short. Make them use the little capillary tube to draw the kid from the kid’s foot and transfer it to the pad, it just Works Better(tm).

Response:

What did your baby actually weigh in the end – was s/he that big?

9lbs 4oz and now at 10yrs he’s still a big bruiser After the baby was born were you advised at all about your diet?

Response:

Hi Val, I have an ultrasound next week to try to estimate the size. I’m 34 weeks now and I’ll probably have another in a few weeks to see how he’s growing. I’m hoping he’s not going to be too big – 10.5 lbs sounds scary! What did your baby actually weigh in the end – was s/he that big? My bg’s in the last week looked fairly stable, but the last two days they’ve gone up again. It’s quite disconcerting to see it when I’m following the diet and insulin schedule, they’ve given me, religiously. My blood sugar had dropped to pre-pregnancy levels within 1 hour of delivery. The GD didn’t appear to have any effect on the delivery other than birthweight. I actually lost weight during the pregnancy from 354 down to 320. The doctor told me I didn’t have diabetes at that point, but believe I probably did by today’s standards.

I’m glad there were no other effects on your baby. After the baby was born were you advised at all about your diet? I’ve been advised that I should try to get to my ideal weight as best I can after the baby (when it is healthy to do so, of course), but do you need to follow any diabetic type diets (certain amounts of carbs at each meal) afterwards? As I recall I just had the 2 iv’s with the meds for the spinal. And then morphine back in my room 8^)

I appreciate you taking the time to give me your experiences, Val Thanks. slowly.

Response:

I’ve been diagnosed with Gestational Diabetes and I’m on insulin (Mixtard 30/70) twice a day. I’m wondering if there’s anyone else reading this group with GD – or if someone has had GD with a previous pregnancy.

Hi Slowly, I had GD 10 yrs ago at age 33, so my experience is pretty out of date. Since I had badly hemoraghed 10 yrs before with my first son (7lbs) I freaked out when the ultrasound estimated baby’s weight at 10.5 lbs 8^) My GP insisted on Natural delivery, so I threw a BIG tantrum with the specialist and had a cesarian. I was on insulin once a day, don’t remember type (possibly NPH) had to keep increasing every couple of days, bg’s just kept going up and up, right up until the night before. My blood sugar had dropped to pre-pregnancy levels within 1 hour of delivery. The GD didn’t appear to have any effect on the delivery other than birthweight. I actually lost weight during the pregnancy from 354 down to 320. The doctor told me I didn’t have diabetes at that point, but believe I probably did by today’s standards. I’m mainly looking for information on the birth process and what ‘interventions’ can occur. My OB has advised I’ll have a glucose drip, insulin pump and hourly blood glucose readings while in labour and I’m looking for other people’s personal experiences.

As I recall I just had the 2 iv’s with the meds for the spinal. And then morphine back in my room 8^) Hope this info is of some help and that all goes well for you, Val

Response:

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